California Technology Assessment Forum recommendation on ADR

[nopain]

The answer of course is Prolotherapy (Okay don't kick me off the boards I'm just teasing to make a point).

Caring Medical in Chicago:

Pain that comes and goes is not originating from a herniated disc. Herniated discs pressing on nerves are severely painful. The person is hunched over, has difficulty moving, and is in obvious distress.

Let's say, for argument's sake, that a person does have a herniated disc pressing on a nerve. The best treatment for this case is Prolotherapy, along with nerve blocks given using plant extracts. In this scenario, the Prolotherapy treatment is given once per month and the nerve blocks are given every week to two weeks, until the nerve pain is resolved. Typically, after three to four nerve blocks, the acute pain is resolved. The more low level chronic pain is helped by the Prolotherapy. This regime has been successful in over 90% (actually closer to 95%) of herniated disc cases at Caring Medical. In the over 45 years the clinic (with Dr. Hemwall) has been treating herniated disc cases, only a handful have needed a surgical procedure.

For all other disc conditions, it is not the disc that is causing the pain. For the person desiring a in-depth explanation as to why this is the case, please read Chapter 17 in the book Prolo Your Sports Injuries Away! entitled, "Prolo Your Back Pain Away!" by Jean-Paul Ouellette, M.D (available by calling Beulah Land Press at 1-800-RX-PROLO or www.beulahlandpress.com.) Dr. Ouellette explains that vertebral instability caused by ligament laxity is the cause of degenerated discs. If a person does not correct the vertebral instability by repairing the ligament laxity, the low back will continue. Epidural cortisone shots, intradiscal electrothermal therapy (IDET), and other anesthesia techniques under fluoroscopy do not repair the ligaments that support the vertebrae. Top

Techniques such as epidural cortisone shots, IDET, and anesthesia-directed nerve blocks are done under fluoroscopy. The cost is enormous, often being in the several thousands of dollars range. We recently saw a patient who stated his IDET procedure cost $6000.00. Prolotherapy to the discs under fluoroscopy (a technique that we do not use) also costs several thousand dollars. All of these procedures do nothing to correct the ligament laxity that is causing the disc degeneration. Prolotherapy is the treatment of choice in this situation.

Epidural cortisone shots do nothing but mask the pain for a week, possibly a month. IDET involves frying or heating up the disc, so, at best, it represents destroying the nerves to the disc. Prolotherapy to the disc sounds great, but in reality, why go through all of the expense of this when all that is needed is Prolotherapy to the lower lumbar vertebrae to repair the ligaments that are causing the degenerated discs?

Hackett-Hemwall Prolotherapy for low back conditions, including degenerative disc disease, spondylolisthesis, spondylosis, and herniated discs, done at Caring Medical has an over 90% success level. There is no need for someone with low back pain to do these other "high-tech" procedures. Hackett-Hemwall Prolotherapy costs $300-400 per session for a complete lower back treatment. The typical patient requires three to six sessions. It is much more cost effective than these other low back procedures that do not stimulate the repair of the painful areas that are causing the degenerative discs.

One should also realize that many people with low back pain have normal MRI's and those with no back pain have terrible discs on MRI's.

only a handful have needed a surgical procedure.

What it didn't work for everyone?

It's the people that these therapies don't work for that Doctors seem to care less about.

One should also realize that many people with low back pain have normal MRI's and those with no back pain have terrible discs on MRI's.

I might just have to punch the next Doctor that throws this bullshit line in my face. While this may be true, the opposite is also true so it's a bullshit statement. To generalize a patients suffering with a statement like this is poor medicine. I've never heard this out of the mouth of a Doctor who understands the suffering of pain patients, only those who think they have all the answers and are quick to dismiss my suffering. I'm not stupid. I get it. MRI's don't diagnose pain, they just provide an image. Why am I venting today?

If I try a therapy and my back pain goes away does that mean that the therapy "works" and that's what everyone should do? That is exactly what the MD that hit the microphone is implying. Maybe a career in Chiropractic would have been more suited to his methods, as they seem to believe they can cure everything too. - ought oh, my ornery side is coming out.

The point being there are many treatments and many advocates of a treatment. To date there is no "cure" that fits all people. So it's extremely frustrating when supposedly educated people are so close minded. The products on the market today may not be the "fix", but if you shut them down and don't investigate further you won't make any progress.

The first airplane didn't fly!!! Neither did the second or third.

Mark you must be incredibly patient to attend these kind of meetings and get shut down in that manner. My personal frustration levels with those kind of Doctors just make me not want to see any Doctors.

People who have not experienced the disability themselves just "Don't get it". Not treating a problem, is not a solution.

What's the cliche'? "You can't keep doing the same thing and expect a different result".

Fortunately this is one group of Physicians and who knows if there is a backdoor agenda.

How does muscle strengthening repair a herniated disc that has collapsed? If the foundation of a building is rotted away, you can patch the walls all you want, the building is still going to fall. When doctors can pinpoint 100% the cause of pain in every case then they can find the magic cure. Until then I have to believe there is a reason people look outside the US for Medical Care.

[Maria]

This sounds akin to those that make Social Security/Medicare policy/decisions/legislation. They just don't *get it*.. and those of us that do, or have to live by it suffer the consequences of the decisions made by those that don't have to really live it.

[wilsonrob]

I have had many surgeries that were successful in which the MRI showed nothing. In addition I have had insurance companies state that their board certified neurosurgeon believed that there was no spine surgery indicated. However, I had the surgery (out of my own pocket) and it got rid of my pain. When I called the insurance company to ask them if they cared about my outcome they did not respond. So obviously this situation is not about the patient.

[dshobbies]

I heard about prolotherapy for my knee. I had a consultation and threw out $75 on that quack. I only had pain for about 1 month, not chronic enough to be treated????? No wonder insurance doesn't cover it!

However, before I condemn this alternative treatment, I will also tell you that I had accupuncture for my nerve damage and it has helped immensely. Not that I'm trying to compare one to the other. Maybe in 500 years we'll give prolotherapy its due.

[nopain]

Who knows if Prolotherapy works. That wasn't really my point. Prolotherapy advocates like to point out C. Everett Koop as a patient/believer. I'd imagine it's like any other treatment - proper patient selection + and experienced Physician.

More interesting to me as a Cervical Spine patient, I don't read a lot of back related ADR literature. So this interested me a bit when I read what Mark wrote...

An MD came up to the audience mike and began talking about a new training regimen called 'pilandes, or something like that.

I don't know what Pilandes is or if it's the same as Pilates? http://en.wikipedia.org/wiki/Pilates (Yeah I know Wikipedia - accept my apology).

Seems like a Yoga type modality to me. Again I don't see how exercise will restore a disc that has completely collapsed. Anyone that watched this past Weeks US Open at Torrey Pines probably knows Tiger Woods has torn cartlidge in his knee. He played through the pain. He "Pilates" right through it! Mind over matter! And now he is off to have surgery, because exercising his bad knee joint caused more pain and damage.

So it's hard for me to fathom that a modality that exercises a severely damaged joint in the back would be any more effective than exercising a severely damaged joint in the knee. And believe me I understand the benefits of exercise to ones body. But mechanical failure is physics and gravity.

I'm sure Mark has knowledge of this interview with Dr. Rosen on the Charite http://www.ethicalspinesurgeon.com/a...ealthpoint.htm.

What I find troublesome is the exclusion of data, but more so the implication that the company behind the device was so eager to push it forward that they were willing to push aside science in the name of profit.

That sets a really bad precedent for other companies who "play by the rules".

It puts the new trials of other disc replacements at an immediate disadvantage in the eyes of the medical community. It's like having a trial by jury except there is no exclusionary process to weed out the juror bias.

I get very frustrated when I read these things.

[Poncho]

I'm impressed with the interesting and well researched responses on this forum.

Unfortunately, many of those that make these so called "informed decisions" based on so many "evidence based" documents may or may not truly understand what living in chronic pain (especially neurogenic) is all about. There are just too many companies out there trying to gain market share for their company - if they can just slide through the approval process to push through their device for a patent......I think most of you can finish out what I am thinking here.

I'm glad that Mark went to represent us as a spine community to shed some light on what living as a spiney with minimal options is all about. Even spine surgeons truly don't understand what living this kind of life is about - unless they suffer a similar injury.

We all need to keep fighting and researching (we - meaning myself included)

Soon, I will try to put up more articles available in the medical community where I work. Hopefully, discussing them will allow for a constructive critical analysis of the data. If such a discussion can help just one person - then I/we are fulfilling our mission on iSpine (in my eyes).

Wishing all less pain / no pain today.

Sincerely,
Poncho (Ponchita)

[nomorepain]

Maybe all of us ADR recipients in the Los Angeles area should go and crash the CTAF meeting and make ADR a part of the local meeting & show how
ADR has changed our lives for the better!!
I'm game, who else?

[ans]

You would think that cost-wise an ADR under the best circumstances is a better option than fusion - especially if there's DDD. Although there may be no incredible evidence (imo) that supports diminished adjacent segment deterioration, is this worth the cost of them paying for another fusion, then another?